editorial sepsis: pathogenesis, biomarkers, and...

EditorialSepsis: Pathogenesis, Biomarkers, and Treatment

Baoli Cheng,1 Andreas H. Hoeft,2 Malte Book,3 Qiang Shu,4 and Stephen M. Pastores5

1Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University,Qingchun Road 79, Hangzhou 310003, China2Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany3Department of Anesthesiology, Bern University Hospital, 3010 Bern, Switzerland4Department of Surgery, Children’s Hospital, School of Medicine, Zhejiang University, Zhejiang, China5Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Correspondence should be addressed to Baoli Cheng; tianwai1979@163.com

Received 5 January 2015; Accepted 5 January 2015

Copyright © 2015 Baoli Cheng et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sepsis is an infection-initiated systemic inflammatory syn-drome with an estimated incidence of 18 million casesannually worldwide. Despite advances in intensive care andsupportive technology, the mortality rate of sepsis still rangesfrom 15% to 80%, reminding scientists and clinicians that itremains to be a major clinical challenge. The key to winningthe “campaign” to combat sepsis is improved understandingof the epidemiology, pathogenesis, and biomarkers of sepsisand discovery of novel therapies. The present special issueshows several encouraging results and provides comprehen-sive reviews of the latest advances in this field.

The effector cells from the innate and adaptive immunesystems play a crucial role in sepsis. Dendritic cells, inparticular, serve as professional antigen presenting cells andare involved in the aberrant immune response to sepsis.In this special issue, X. Fan et al. discuss the effects ofsepsis on the amount, surface molecule expression, cytokinesecretion, and T-cell activating function of dendritic cells andthe underlying mechanisms in their review “Alterations ofDendritic Cells in Sepsis: Featured Role in Immunoparalysis.”Recent postmortem studies of patients who died of sepsisshowed that depletion of CD4 and CD8 lymphocytes is animportant characteristic. Thus, knowledge of these circu-lating lymphocyte abnormalities is relevant for the under-standing of sepsis pathophysiology. R. de Pablo et al., whohave previously reported on the alteration of B cells, naturalkiller cells, and T-cell function in septic patients, summarizetheir latest findings on the role of blood lymphocytes in

sepsis and discuss the different kinetic patterns of lymphocytesubsets and their relationship to outcome in their review“Role of Circulating Lymphocytes in Patients with Sepsis.”Both the clinical and basic researches have shown that sepsis-associated immunosuppression is associated with adverseoutcomes. A novel heterogeneous population of imma-ture myeloid cells that possess immunosuppressive activ-ities, termed myeloid-derived suppressor cells (MDSCs),has gained much attention in recent sepsis studies. D.Lai et al. discuss the complex functions of MDSCs inthe pathogenesis of sepsis. Their review “Myeloid-DerivedSuppressor Cells in Sepsis” also proposes that the overallrole of MDSCs involves much more than simply being animmunosuppressive cell population. These 3 review articlesprovide a comprehensive analysis of the major importantimmune cells in sepsis and highlight potential therapeutictargets. As a group who have investigated the function of thefamily of defensins in sepsis for nearly 10 years, G.-H. Xieet al. summarize the in vitro, in vivo, and genetic studies onthe effects of defensins as well as the corresponding mech-anisms within sepsis. Their review, “Defensins and Sepsis,”also points out that the function of defensins reflects boththeir immunomodulatory and broad-spectrum antimicrobialeffects.

Although the international Surviving Sepsis Campaignguidelines have been released for 10 years, sepsis remains afatal syndrome due to the lack of efficient biomarkers andnovel treatments. D. N. Nguyen et al. investigated plasma

Hindawi Publishing CorporationBioMed Research InternationalVolume 2015, Article ID 846935, 2 pageshttp://dx.doi.org/10.1155/2015/846935

2 BioMed Research International

cortisol levels in septic patients with delirium and comaand found that cortisol is a potential biomarker of braindysfunction in their article “Cortisol Is an Associated-RiskFactor of Brain Dysfunction in Patients with Severe Sepsisand Septic Shock.” F. Song et al. and P. Madhusudan et al.discuss two important but controversial issues related to theSurviving Sepsis Campaign Guidelines. In a meta-analysis of12 randomized trials involving 4100 septic patients, “IntensiveInsulin Therapy for Septic Patients: A Meta-Analysis of Ran-domized Controlled Trials,” F. Song et al. reported no benefitand a higher incidence of hypoglycemiawith intensive insulintherapy compared with conservative glucose management. P.Madhusudan et al. discuss the current debate on the choice,amount, and end points for fluid resuscitation in sepsis intheir review “Fluid Resuscitation in Sepsis: Reexaminingthe Paradigm.” K. Xie et al. investigated the therapeuticfunction of hydrogen gas in a septic animal model for severalyears, and, in their present review, “Hydrogen Gas Presents aPromising Therapeutic Strategy for Sepsis,” they summarizethe progress of hydrogen treatment in sepsis. J. Zhou et al. andX. Li et al. explore novel drugs for sepsis from the perspectiveof the neuroendocrine network in sepsis in their two studies,“Epinephrine Enhances the Response of Macrophages underLPS Stimulation” and “Agmatine Protects against Zymosan-Induced Acute Lung Injury in Mice by Inhibiting NF-𝜅B-Mediated Inflammatory Response.”

In this present special issue about the pathogenesis,biomarkers, and treatment of sepsis, the authors providecomprehensive reviews and attractive research perspectiveson the mechanisms of sepsis which we hope will inspireresearchers investigating novel biomarkers and therapeuticsepsis targets.

Acknowledgment

This study was supported by National Natural Science Foun-dation of China (no. 81102226).

Baoli ChengAndreas H. Hoeft

Malte BookQiang Shu

Stephen M. Pastores

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